Barium meal is a radiological study used to examine the esophagus, stomach, duodenum, and proximal jejunum. It involves oral administration of barium contrast media. There are several types of barium meal studies including single contrast, double contrast, and biphase studies. Single contrast studies visualize the gross anatomy while double contrast studies provide better mucosal detail using barium and gas contrast. Barium meal exams can detect abnormalities such as ulcers, masses, polyps, and narrowings that may indicate conditions like peptic ulcer disease, gastritis, cancer, or motility disorders.

1. BARIUM MEAL
DR.Athul.D
JR MDRD
KMC

2. • Barium meal is the radiological study of oesophagus, stomach, duodenum and
proximal jejunum. It is done by oral administration of contrast media.
• Gross anatomy
• Cardiac sphincter / Oesophageal sphincter
• Stomach
• Fundus
• Body
• Pyloric antrum
• Rugae
• Pyloric sphincter
• Greater/lesser curve
• duodenum

3. stomach

5. INDICATIONS
• 1. Symptoms which prompts
Barium meal study are :
• (a) Epigastric pain suggestive
of peptic ulceration.
• (b) Anorexia.
• (c) Weight loss.
• (d) Vomiting.
• (e) Anaemia.
• (f) Heart burn.
• (g) Dyspepsia.
2. Upper abdominal mass.
3. Gastro-intestinal haemorrhage.
4. Gastric or duodenal obstruction
5. Malignancies of oesophago-gastric junction,
stomach and duodenum.
6. Systemic diseases like Tuberculosis
7. Motility disorders of gastro-intestinal tract.
8. In children for vomiting due to :
(i) Gastroesophageal reflux;
(ii) Pyloric obstruction;
(iii) Malrotation

6. CONTRAINDICATIONS
• Suspected cases of gastro-duodenal perforation
• History or suspicion of aspiration.
• Large bowel obstruction (Barium inspissation occurs) •
• Fistulous communication with any organs
• Recent biopsy from GIT, ( barium granuloma may form)

7. PREPARATION
Fasting for 6 hours/over night fasting
• Avoid cigarette smoking as it may interfere with optimum coating
of the mucosa.
• In patients with gastric outlet obstruction, prolonged fasting or I.V
Metaclopramide and sometimes nasogastric intubation and aspiration
of the contents may be necessary

8. CONTRAST MEDIA
• Single Contrast Study
• Low density barium suspension (80-100% w /v) is used.
• Water soluble contrast media are indicated when a gastro-
duodenal perforation is suspected.
• Use of newer non-ionic water soluble contrast
media(Gastromicro) is used, when there is risk of aspiration.

9. CONVENTIONAL SINGLE CONTRAST STUDY
• 80-90 kV.
• 10-15 ml of 80-100% w/v barium suspension is given
• patient lying supine is rotated with the right side going up in a continuous
clockwise manner for obtaining a good coating of the entire stomach mucosa.
• 100-250 ml of barium is given. Spot films of the filled fundus in varying
obliquity may be taken.

10. • Patient is turned prone oblique right side dependent as
barium enters the duodenum through the pylorus. Spot films
for duodenal bulb and C loop can be taken and also in right
anterior oblique view.
• More barium is given to distend the stomach wall . The gastric
peristalsis and rate of emptying through the pylorus is
observed. The patient is rotated under fluoroscopy to observe
all margins

11. • In erect position, right anterior oblique view of stomach shows
incisura angularis & Proximal jejunum
• For retrogastric space, about 200-250 ml of barium is given in
supine position,& translateral film is taken

12. ANTEROPOSTERIOR
• Patient position
• Supine
• Arms at sides outside
of radiographic field
• Gonad shielding

14. Normal reticular pattern to the mucosa. (
2-4mm)

15. RIGHT ANTERIOR OBLIQUE (RAO)
• Especially
pyloric canal
and duodenal
bulb
• Patient position
• Semiprone (RAO)
• Patient head in right
lateral position
• Gonad lead protection
This is a right anterior oblique (RAO) position because the right side of the
anterior body surface is closest to the IMAGE RECEPTOR

17. LEFT POSTERIOR OBLIQUE
(LPO)
(AP OBLIQUE)• Especially fundus
• Pyloric canal and
duodenal bulb
should be seen
without
superimposition
• Patient position
• LPO
• Patients head on
pillow
• Left arm extended
away from body, to
prevent unwanted
superimposition
• Gonad protection

19. LATERAL
• Especially anterior and posterior walls of
stomach, duodenal bulb, and duodenal
loop.
• Patient position
• Right lateral
• Raise patients arms,
• Flex knees
• Gonad protection

21. LEFT ANTERIOR OBLIQUE (LAO):
LAO – to demonstrate the lesser
curvature

22. LAO – to demonstrate the lesser
curvature

23. PA AXIAL

24. Barium –PA stomach, single contrast study
EVALUATION CRITERIA:
• ENTIRE STOMACH VISIBLE.
• BODY AND PYLORUS
FILLED WITH CONTRAST
AGENT.
• SUFFICIENT GAS
RETAINED WITH SUITABLE
CONTRAST COATING TO
SEE GASTRIC MUCOSA.

25. ADVANTAGES OF SINGLE CONTRAST STUDIES
• for patients who are immobile or unable to swallow gas
forming tablets.
• Pylorospasm, fistulae and enlarged gastric rugae are best
seen.
• Filling defects due to large masses in pyloric and duodenal
region are more easily seen than in double contrast
• It is the procedure of choice to examine patients with
suspected gastric or duodenal obstruction.

26. DISADVANTAGES OF SINGLE CONTRAST STUDY
• Lack of sensitivity in detecting small erosion/linear
ulceration, superficial gastric carcinomas and subtle
mucosal abnormalities.

28. Barium meal- single contrast

29. Demonstration of rugal folds

30. DOUBLE CONTRAST BARIUM STUDY
Used in Japan with high incidence of gastric malignancy.
for mass screening of the gastric tumours for early detection.
relies much less on fluoroscopy and more on filming which
is done overcouch for better image quality.
found very useful for small mucosal lesions like polyps,
mucosal erosions and ulcers, recurrent tumours and post
operative studies.

31. PREPARATION
A 'dry' fluid free stomach is essential. Double contrast study
should not be done if secretions exist in the stomach. The
secretions will prevent adequate mucosal coating and may
mimic tumours

32. CONTRAST MEDIA
High density (200-250% w /v) low viscosity barium sulphate is essential.
High viscosity barium does not flow well and does not coat mucosa well,
hence can produce apparent mucosal lesions.
Antifoaming agents which are added to barium suspension prevent air
bubble formation. Air bubbles can mimic polyps.

33. GAS FORMING AGENT
• Sodium bicarbonate and Citric acid are given orally. When
they come in contact in the stomach, carbon dioxide is
produced which acts as negative contrast.
• When Ryle' s tube is placed in the stomach, this can be used
to inject air.

34. TECHNIQUE OF DOUBLE CONTRAST
About 100-150 ml of high density low viscosity barium is given.
Injection Buscopan IV - given just before giving barium to study the
stomach.
To study the stomach and duodenum, injection its given when barium
enters the duodenum.
Gas forming agents are given.
Then patient is rotated slowly for mucosal coating.

35. • Advantages of double contrast study
• • Highly accurate method of detecting
abnormalities
• following gastric surgery
• bile reflux gastritis
• marginal ulceration
• recurrent carcinomas
• abnormalities of the efferent
loop.
Disadvantages of double contrast study
• Probably misses some polyps,
ulcers, erosions, superficial
carcinoma.

36. Angular Notch
Incisura Angularis
Barium Meal, Double Contrast
(Supine Position)
BodyAntrum
Supine Position:
Note Barium Distribution
in the Fundus due to
gravity

38. BIPHASIC STUDY OF UPPER GIT
Introduction
• Gives good anatomic & physiologic information & has accuracy comparable to
endoscopy.
Goal
• To have both mucosal delineation in double contrast phase & full column distention
in single contrast phase

39. FILMING
• • Duodenal spot filming is done first to avoid flooding of the bowel
• (a) Prone oblique Rt.side down Duodenal cap, C-loop
• (b) Supine with Rt. side up oblique : Duodenum
• (c) Erect - Gastric fundus
• (d) Supine with 60° head up- Upper body of Stomach
• (e) Supine - Lower body of Stomach, Pyloric antrum
• (f) Supine with Rt. side up oblique : Pyloric antrum & Canal.

40. Inflammatory and
Ulcerative Diseases

41. • Double-contrast : Thickened, lobulated
folds are present in the body and antrum of
the stomach
• Double-contrast : Nodular fold
thickening is present in the
gastric antrum.
Differential Diagnosis
1. Gastritis (e.g., caused by Helicobacter pylori, alcohol, medication)
2. Zollinger-Ellison syndrome
3. Lymphoma

42. Double-contrast : Multiple
small, round filling
defects (mounds of edema)
(arrows) containing a small
central collection of barium
(erosion or tiny ulceration)
are present in the gastric
antrum and body.
Differential Diagnosis
1. Acute erosive (varioliform)
gastritis
2. Barium precipitate
3. Crohn disease
4. Infectious gastritis (viral
or fungal)

43. Findings
Single-contrast :
An ulcer crater is located
along the
lesser curvature of the
gastric antrum.
Symmetric and
smoothly contoured folds
radiate to the crater.
The mound of edema is
smooth in contour, and the
crater is located centrally
within the mound.
Differential Diagnosis
Benign gastric ulcer

44. Findings
Double-contrast: An ulcer crater is present on the
greater curvature of the stomach. A smooth mound of edema
surrounds the centrally located ulcer. The crater does not extend
beyond the normal gastric lumen contour.
Differential Diagnosis
1. Benign sump ulcer
2. Gastric adenocarcinoma
3. Intramural diverticulum

45. FEATURES BENIGN ULCER MALIGNANT ULCER
INCIDENCE 95% 5%
MARGIN SMOOTH & ROUND IRREGULR,HEAPED
UP
LOCATION DISTAL STOMACH
& LESSER
CURVATURE
FUNDUS AND
GREATER
CURVATURE
BASE SMOOTH & CLEAN SHAGGY &
NECROTIC
RADIATING FOLDS SMOOTH AND
SYMMETRICAL AND
REACH UPTO EDGE
OF ULCER
DISTORED FIOLDS
THAT DON’T REACH
UPTO THE EDGE
ULCER COLLAR THICKER AND
SMOOTH
KIRKIN COMPLEX
(heaped margins
touching bed cause
lucent rim around
ulcer on barium meal)
Pathogonomic sign Hamptons line
(a thin sharp lucent line
Carman’s meniscus
( A large flat based

47. Findings
Single-contrast : An ulcer crater is
seen on this
tangential view of the gastric
antrum. A Hampton line
(arrow) is seen at the base of the
crater.
Differential Diagnosis
Benign gastric ulcer

48. • MASSES AND FILLING
DEFECTS
• Benign Tumors
• Malignant Tumors

49. Double-contrast :
Multiple polypoid
filling defects are
present in the
stomach.
Differential Diagnosis
Gastric polyps

50. Findings
Double-contrast :
Innumerable small polyps
are present throughout the
stomach. They are most
numerous within the
fundus.
Differential
Diagnosis
1. Gastric polyps
2. Fundic gland
polyposis syndrome

51. Findings
Double-contrast : A
polypoid irregular
surface filling defect
(arrowhead) is present
in the gastric fundus
and cardia.
Differential Diagnosis
1. Gastric adenocarcinoma
2. Gastrointestinal stromal
tumor
3. Lymphoma
4. Solitary varix
5. Metastases

52. Single-contrast : The gastric antrum is
markedly narrowed by a large
constricting mass.
Enhanced abdominal CT. A large
polypoid mass is seen arising from the
anterior wall of the gastric antrum.
Differential Diagnosis
1. Gastric carcinoma
2. Lymphoma

53. A. Double-contrast : Marked rugal
fold
thickening is present throughout
the stomach. Multiple nodules are
also present throughout the
duodenum.
B. Double-contrast : Diffuse nodularity and
fold thickening are present within the gastric
body and fundus.
Differential Diagnosis
1. Lymphoma
2. Menetrier disease
3. Gastric adenocarcinoma
4. Metastases

54. NARROWINGS

55. Findings
Single-contrast : Within
the gastric antrum,
there is symmetric,
smooth, tapered
narrowing.
Differential Diagnosis
1. Scarring from chronic peptic
ulcer disease
2. Granulomatous disease
(Crohn disease, sarcoidosis,
tuberculosis, syphilis,
eosinophilic gastroenteritis)
3. Scirrhous carcinoma

56. Findings
Single-contrast :
The distal third of the stomach
is
narrowed, tapered, and
nondistensible.
Differential Diagnosis
1. Chronic peptic ulcer disease
2. Granulomatous disease
(Crohn disease, sarcoidosis,
tuberculosis, syphilis,
eosinophilic gastroenteritis)
3. Gastric carcinoma
4. Metastatic breast cancer
5. Prior caustic ingestion

57. Findings
Double-contrast :
The antrum of the stomach is
irregularly narrowed. There is
an abrupt margin at the
junction of the antrum and
body along the greater
curvature.
Differential Diagnosis
1. Caustic gastric stricture
2. Annular carcinoma
3. Granulomatous infection

58. DUODENUM

59. Single-contrast :
Multiple thick and
nodular folds are
present in the first
and second portions
of the duodenum.
A diverticulum
(arrows) is seen
lateral to the
descending
duodenum.
Differential Diagnosis
1. Duodenitis
2. Brunner gland
hyperplasia
3. Crohn disease

60. Findings
Double-contrast :A
lobulated filling defect
occupies the medial wall of
the second portion of the
duodenum
Differential Diagnosis
1. Ampullary neoplasm
2. Edematous papilla
(recent stone passage or
impacted
stone)
3. Duodenal polyp

61. Single-contrast :The proximal
transverse duodenum is
dilated to the level of the
spine. The bowel abruptly
narrows and appears to be
pinched closed by a linear
extrinsic mass. The
underlying duodenal mucosa
is intact.
Differential Diagnosis
1. Superior mesenteric artery
syndrome
2. Duodenal neoplasm
3. Abdominal aortic aneurysm

62. Thank you